Form SS-8

(Rev. December 2023)

Determination of Worker Status for Purposes 

 of Federal Employment Taxes and 

Department of the Treasury Income Tax Withholding

Internal Revenue Service Go to www.irs.gov/FormSS8 for instructions and the latest information.

OMB. No. 1545-0004

For IRS Use Only: 

Case Number: 

Earliest Receipt Date:

Disclosure of Information

The information provided on Form SS-8 may be disclosed to the firm, worker, or payer named below to assist the IRS in the determination process. 

For example, if you are a worker, we may disclose the information you provide on Form SS-8 to the firm or payer named below. The information can 

only be disclosed to assist with the determination process. See Privacy Act and Paperwork Reduction Act Notice in the separate instructions for more 

information. If you do not want this information disclosed to other parties, do not file Form SS-8.

IMPORTANT THINGS YOU SHOULD KNOW

• The Form SS-8 must be fully completed. If you provide incomplete information, we may not be able to process 

your request.

• All questions in Parts I through IV must be explained with clear concise answers. 

• Part V must be completed if the worker provides a service directly to customers or is a salesperson. 

• If you cannot answer a question, enter “Unknown” or “Does not apply.” 

• If you need more space for a question, attach another sheet with the part and question number clearly identified. Write 

your firm’s name (or worker’s name) and employer identification number (or social security number) at the top of each 

additional sheet attached to this form.

• You MUST include copies of the Forms W-2, 1099-MISC, and/or 1099-NEC for each year you are contesting. See instructions.

Name of firm (or person) for whom the worker performed services

Firm’s mailing address (include street address, apt. or suite no., city, state, and ZIP code)

Trade name

Firm’s fax number Firm’s website

Firm’s telephone number (include area code) Firm’s employer identification number

Worker’s name

Worker’s mailing address (include street address, apt. or suite no., city, state, and ZIP code)

Worker’s daytime telephone number Worker’s alternate telephone number

Worker’s fax number Worker’s social security number

Worker’s employer identification number (if any)

Note: If the worker is paid for services performed for a business or individual not listed above, enter the name, address, and taxpayer identification number 

of that business/individual who paid the worker, if known. Explain the relationship between the firm and the business/individual who paid the worker.

Part I General Information

1 This form is being completed by: Firm Worker 

for services performed from beginning date

MM/YYYY

to ending date

MM/YYYY

.

Caution: Filing Form SS-8 does not prevent the expiration of the time in which a claim for refund must be filed.

2 Explain your reason(s) for filing this form.

You received a bill from the IRS You believe you erroneously received a Form 1099 or Form W-2

You are unable to get workers’ compensation benefits You were audited or are being audited by the IRS

Other (specify)

Don’t complete this form if payment was received for reasons unrelated to Form SS-8. See instructions.

Did you remember to answer all questions and 

refer to the Instructions for Form SS-8 at www.irs.gov/pub/irs-pdf/iss8.pdf?

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 16106T Form SS-8 (Rev. 12-2023)
Form SS-8 (Rev. 12-2023) Page 2

Part I General Information (continued)

3 Total number of workers who performed or are performing the same or similar services: .

4 How did the worker obtain the job? Attach any advertisement.

Application Bid Employment agency Other (specify)

5 Attach copies of all supporting documentation (for example, contracts; invoices; memos; Forms W-2, Forms 1099-MISC, or Forms 

1099-NEC issued or received; IRS closing agreements; or IRS rulings).

a Inform us of any current or past litigation concerning the worker’s status.

b If no income reporting forms (Form 1099-MISC, 1099-NEC, or W-2) were furnished to the worker, enter the amount of income earned for the 

year(s) at issue $ .

c If both Form W-2 and Form 1099-MISC, or both Form W-2 and Form 1099-NEC, were issued or received, explain why.

6 Describe the firm’s business.

7 Did the worker receive pay from more than one entity (for example, two or more entities with different taxpayer identification numbers) because 

of a business sale, merger, acquisition, or reorganization? No. Skip to line 8. Yes. Complete the rest of line 7.

Name of the firm’s previous owner:

Previous owner’s taxpayer identification number: Change was a: Sale Merger Acquisition Reorganization

Other (specify)

Description of above change:

Date of change (MM/DD/YY):

8 What is the worker’s job title?

Describe the worker’s duties.

9 Which do you believe the worker is? Check only one. Employee Independent contractor

Explain.

10 Did the worker perform any services for the firm before or after the dates entered on line 1 on page 1 of this form? . . Yes No

If “Yes,” what were the dates of service?

If “Yes,” explain any differences between the services provided.

11a Is the work done under a written agreement between the firm and the worker? . . . . . . . . . . . . . Yes No

If “Yes,” attach a copy (preferably signed by both parties).

If “Yes,” describe the terms and conditions of the work arrangement.

b Is the work done under an oral agreement? . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” describe the details of the agreement.

Part II Behavioral Control (Provide names and titles of specific individuals, if applicable.)

1 What specific training and/or instruction is the worker given by the firm?

2 Who gives the worker work assignments?

How are the assignments received? In person Phone Email Text message

Other (specify)

3 Who determines the methods by which the assignments are performed?

4 If problems or complaints arise, who is contacted?

Who is responsible for their resolution?

Did you remember to answer all questions and 

refer to the Instructions for Form SS-8 at www.irs.gov/pub/irs-pdf/iss8.pdf?

Form SS-8 (Rev. 12-2023)
Form SS-8 (Rev. 12-2023) Page 3

Part II Behavioral Control (Provide names and titles of specific individuals, if applicable.) (continued)

5 Is the worker required to complete reports? . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” attach examples.

6a How frequently does the worker perform services? As scheduled As needed As available

Other (specify)

b Describe the worker’s primary services. Sales Timesheets Patient logs

Other (specify)

7 Where are the services performed? If more than one location, what percentage of the worker’s time is spent at each location?

Firm premises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . %

Worker’s office or shop . . . . . . . . . . . . . . . . . . . . . . . . . . . . %

Customer’s location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . %

Other (specify) %

8a Is the worker required to attend meetings? . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” what type of meetings? Sales Staff Other (specify)

b Is the worker penalized if unable to attend a meeting? . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” what is the penalty?

9 Is the worker required to provide the services personally? . . . . . . . . . . . . . . . . . . . Yes No

10 Can the worker hire substitutes or helpers? . . . . . . . . . . . . . . . . . . . . . . . Yes No

11 If the worker hires the substitutes or helpers, is approval required? . . . . . . . . . . . . . . . . Yes No

If “Yes,” who approves the hiring? Firm Other (specify)

12 Does the worker pay substitutes or helpers? . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” is the worker reimbursed? . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If the worker is reimbursed, explain who reimburses them.

Part III Financial Control (Provide names and titles of specific individuals, if applicable.)

1a List the supplies, equipment, materials, and property provided by

The firm:

The worker:

b Are supplies, equipment, materials, or property provided by another party? . . . . . . . . . . . . . . Yes No

If “Yes,” explain.

2 Does the worker lease equipment, space, or a facility? . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” what are the terms of the lease? (Attach a copy or explanatory statement.)

3 Are expenses incurred by the worker in the performance of services for the firm? . . . . . . . . . . . . Yes No

If “Yes,” explain.

4a Are expenses reimbursed by the firm? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” provide the frequency and amount.

b Are expenses reimbursed by another party? . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” explain.

5a What type of pay does the worker receive? Salary Commission Hourly wage Piece work Lump sum

Other (specify)

b If paid commission, does the firm guarantee a minimum amount of pay? . . . . . . . . . . . . . . . Yes No

If “Yes,” explain.

6 Can the worker request advance pay? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” how often? Daily Weekly Monthly Other (specify)

7 Whom does the customer pay? . . . . . . . . . . . . . . . . . . . . . . . . . Firm Worker

If worker, does the worker pay the total amount to the firm? Yes No If “No,” explain.

8 Does the firm carry workers’ compensation insurance on the worker? . . . . . . . . . . . . . . . Yes No

Did you remember to answer all questions and 

refer to the Instructions for Form SS-8 at www.irs.gov/pub/irs-pdf/iss8.pdf?

Form SS-8 (Rev. 12-2023)
Form SS-8 (Rev. 12-2023) Page 4

Part III Financial Control (Provide names and titles of specific individuals, if applicable.) (continued)

9a Does the worker take a financial risk by performing services? . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” explain.

b Can the worker suffer a financial loss by performing services? . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” explain.

10a Who sets the rate of pay for the services performed? Firm Worker Other (specify)

b If products are sold, who sets the product price? Firm Worker Other (specify)

Part IV Relationship of the Worker and Firm

1 Are benefits made available to the worker? . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” which benefits are available? Paid vacations Sick pay Paid holidays

Personal days Pensions Insurance benefits Bonuses

Other (specify)

2 Can the firm or worker end the work relationship without penalty? . . . . . . . . . . . . . . . . Yes No

If “No,” explain.

3 Did the worker perform similar services for others during the time period entered in Part I, line 1? . . . . . . . Yes No

If “Yes,” is the worker required to get approval from the firm? . . . . . . . . . . . . . . . . . . Yes No

4 Is there an agreement prohibiting competition between the firm and the worker? . . . . . . . . . . . . Yes No

If “Yes,” explain or attach available documentation.

5 Reserved for future use. 

6 Does the worker advertise? . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” what type of advertising does the worker do? Provide copies, if available.

7 Does the worker assemble or process a product at home? . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” who provides the materials and instructions or patterns?

If “Yes,” what does the worker do with the finished product? Return to the firm Provide to another party Sell it

Other (specify)

8a Does the firm introduce the worker to its customers? . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” how is the worker introduced? Employee Partner Representative Contractor

Other (specify)

b Under whose name are services performed? Firm Worker

Other (specify)

9 Does the worker still perform services for the firm? . . . . . . . . . . . . . . . . . . . . . Yes No

If “No,” how did the work relationship end? Firm ended the work relationship Worker ended the work relationship

Job completed Contract ended Firm or worker went out of business

Other (specify)

Part V For Service Providers or Salespersons. You must complete this part if the worker provided a service 

directly to customers or is a salesperson.

1 Is the worker responsible for contacting potential new customers? . . . . . . . . . . . . . . . . Yes No

If “Yes,” what are the worker’s specific responsibilities?

2 Is the worker provided leads (names and contact information) for potential new customers? . . . . . . . . . Yes No

If “Yes,” who provides the leads?

3 Is the worker required to report on potential new customers contacted? . . . . . . . . . . . . . . . Yes No

If “Yes,” what are the reporting requirements?

4 Does the firm set terms and conditions of sale? . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” explain.

5 Are orders submitted and subject to the firm’s approval? . . . . . . . . . . . . . . . . . . . Yes No

6 Who determines the worker’s sales territory? Firm Worker

Other (specify)

Did you remember to answer all questions and 

refer to the Instructions for Form SS-8 at www.irs.gov/pub/irs-pdf/iss8.pdf?

Form SS-8 (Rev. 12-2023)
Form SS-8 (Rev. 12-2023) Page 5

Part V For Service Providers or Salespersons. You must complete this part if the worker provided a service 

directly to customers or is a salesperson. (continued)

7 Did the worker pay for the privilege of serving customers on the route or in the territory? . . . . . . . . . . Yes No

If “Yes,” whom did the worker pay?

If “Yes,” how much did the worker pay? . . . . . . . . . . . . . . . . . . . . $

8 Where does the worker sell the product? Home Retail establishment Online

Other (specify)

9 List the product and/or services distributed by the worker (for example, meat, vegetables, fruit, bakery products, beverages, or laundry or dry 

cleaning services). If more than one type of product and/or service is distributed, specify the principal one.

10 Does the worker sell life insurance full time? . . . . . . . . . . . . . . . . . . . . . . . Yes No

11 Does the worker sell other types of insurance for the firm? . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” enter the percentage of the worker’s total working time spent in selling other types of insurance . . . . . %

12 Does the worker solicit orders from wholesalers, retailers, contractors, or operators of hotels, restaurants, or other similar 

establishments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” what percentage of the worker’s time is spent in solicitation? . . . . . . . . . . . . . . . %

13 Is the merchandise purchased by the customers for resale or use in their business operations? . . . . . . . . Yes No

Describe the merchandise and state whether it is equipment installed on the customers’ premises.

Sign 

Here

Under penalties of perjury, I declare that I have examined this request, including accompanying documents, and to the best of my knowledge and belief, the 

facts presented are true, correct, and complete.

Print your name Signature Date 

Did you remember to answer all questions and 

refer to the Instructions for Form SS-8 at www.irs.gov/pub/irs-pdf/iss8.pdf? 

Did you sign Form SS-8? 

Did you attach copies of your Form W-2 or Form 1099 for each year contested?

Form SS-8 (Rev. 12-2023)